| NPI | 1770557175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery Pediatric Surgery (Licence: DC MD038997) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD073515L) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-05-11 |